Acute kidney injury in survivors of surgery for severe traumatic brain injury: Incidence, risk factors, and outcome from a tertiary neuroscience center in India

Abstract

Background. Non-neurological complications like acute kidney injury (AKI) can affect outcome of traumatic brain injury (TBI). This study aims to analyze the incidence, predictive factors, and impact of AKI in operated patients with severe TBI. Methods. We retrospectively reviewed the data of 395 patients who underwent surgery for severe TBI and survived to be discharged from the hospital over a 1-year period. Of these, 95 patients were finally included in the analysis. Their demographic data, laboratory parameters, and clinical courses were reviewed. Diagnosis and staging of AKI was made using Acute Kidney Injury Network (AKIN) criteria. Results. The incidence of AKI was 11.6% (11 patients). Out of the11 patients who had AKI, 7 were in stage I (63.6%), 3 were in stage II (27.3%), and 1 in stage III (9.1%). Nine Patients (81.8%) developed AKI within 5 days of admission. Aminoglycoside therapy had an association with occurrence of AKI. There was no mortality and none of the patients required renal replacement therapy (RRT). Renal function of all these patients returned to baseline before hospital discharge. Hospital stay and intensive care unit (ICU) stay were longer and Glasgow coma scale (GCS) was lower in patients with AKI when compared with patients without AKI group at discharge. Conclusion. Reversible AKI without need for RRT occurred in nearly12% of patients with severe TBI requiring surgical intervention. Aminoglycoside therapy was the only predictive factor for the occurrence of AKI. Patients with AKI have a longer period of mechanical ventilation, longer ICU and hospital stay, and poorer GCS at discharge.